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Clinical |
Department of Surgery, Selayang Hospital, Kuala Lumpur, Selangor, Malaysia
Correspondence to: Y.H. Goh, Department of Surgery, Selayang Hospital, 68100 Batu Caves, Selangor, Malaysia. henggoh{at}hotmail.com
Background: Omental wrap is a common cause of catheter
obstruction. Current laparoscopic techniques for correcting obstruction
include omentopexy and omentectomy. This study evaluates the efficacy of a new
laparoscopic technique for revision of obstructed peritoneal dialysis
catheters. Methods: Between November 2005 and November 2006, the
technique was applied in 18 patients (6 female, 12 male; median age 50 years,
range 16 – 73 years) on continuous ambulatory peritoneal dialysis with
catheter malfunction secondary to omental wrap. Pneumoperitoneum was induced
under general anesthesia. Three ports were inserted. The catheter was released
from the omentum and repositioned in the pelvis. The omentum was then folded
onto itself in a cephalad direction using silk sutures. This shortened the
omentum. The risk of catheter migration was minimized with a polypropylene
sling passed through the abdominal wall and around the catheter, then knotted
subcutaneously. The sling allowed catheter removal without a new laparoscopy.
The outcomes were prospectively evaluated. Results: Median operating time was 90 minutes (range 35
– 160 minutes). Adhesiolysis was performed in 4 patients: 1 patient had
port-site leakage of dialysate, which settled with abdominal rest; 1 patient
had bleeding during adhesiolysis and laparoscopic hemostasis was successful; 1
patient had recurrent catheter obstruction 2 weeks post-operatively and was
converted to hemodialysis; and 1 patient had recurrent malfunction secondary
to small bowel wrap after 5.5 months; re-salvage was successful. The success
rate of the first salvage procedure was 89%(16/18). The catheters were still
functioning after a mean follow-up of 16.5 ± 6.3 months (range 0.5
– 24 months). The 1-year catheter survival rate was 83.3%. Conclusions: Omental folding is a safe and effective
technique for salvaging peritoneal dialysis catheters.
KEY WORDS: Peritoneal catheter; laparoscopy; omental folding; catheter sling.
Received 26 January 2008; accepted 18 April 2008.
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